“This can’t be…”
“Maybe they missed something…”
All of us can relate to the feeling of being overwhelmed by persistent negative thoughts. Thoughts of hopelessness or helplessness make you feel trapped with no place to escape.
Physical or psychological pain, financial stress, problematic relationships, and past traumatic events are often a part of life. And when you become fused to thoughts, it changes behaviour.
Has pushing thoughts aside, distracting yourself, avoiding them, or trying to replace them made the pain go away?
Making Pain Go Away, or Making Way?
Traditional cognitive behavioral therapy aims to identify, neutralize, reduce, and revert ‘maladaptive’ cognitions, thoughts, feelings and emotions that frame actions and behaviors. Acceptance and Commitment Therapy (ACT) proposes instead we open up to (accept) the existence of such unpleasant feelings and sensations. To normalize the idea that struggling with them is not beneficial, especially when they cause further suffering or harm (1).
ACT seeks to cultivate acceptance (willingness) as opposed to “experiential avoidance” (attempts to avoid thoughts, feelings, memories, images, and physical sensations—even when doing so creates harm) (2). Avoiding negative or unpleasant thoughts and behaviors is a core coping strategy and self-defense. But by giving them no space, by not resolving them, they may grow to become a recurrent source of unhappiness and distress. For physical therapists, assessing whether experiential avoidance is also at the core of their client’s struggles with pain or disability is key to create a therapeutic plan that works.
Accept What Can’t be Changed, Focus on What Matters Most
Life is a journey where suffering sometimes happens. To live is to suffer, to survive is to find some meaning in the suffering. This is central to Buddhist philosophy, which teaches acceptance of suffering as a starting point to transcend its burden and live a calmer, fuller life (3).
With similarities to some Buddhist practices, and linked to the conception of mindfulness, ‘acceptance’ is one of the six core processes of ACT. The six core processes (Acceptance, Cognitive Defusion, Present Moment Awareness, Self as Context, Values, and Committed Action) depict both the interface between human language and cognition and the control of human behavior by direct experience (4). Through interventions that target these processes, ACT promotes what is known as “psychological flexibility” to alleviate psychological distress and improve functioning (5, 6).
ACT is a third wave psychotherapy that combines elements from traditional cognitive behavioral therapy, but instead of seeking to alter thinking patterns, it focuses on changing the stance towards them.
Let it Be (Control No More)
We struggle to make sense and find meaning in a world that often seems to lack it. We want things to be predictable, identifiable and repeatable. We want consistency. For things to make sense, we need to feel and be sure that we are in control. When we aren’t, anxious thoughts and unpleasant emotions may influence or control us instead.
Acceptance in ACT refers to the ability to openly and willingly embrace things and facts of life over which we have no direct control, in order to pursue the values and goals -either material, affective, or spiritual- that make us feel fulfilled. Advocates of ACT are quick to note that acceptance is not an end in itself. It does not mean self-abandonment or giving up, but a healthy resignation towards what can’t be (7). Acceptance is also a first and necessary step to clear the way for commitment to fruitful action that allows us to be better off, despite grief, worries, anguish, or pain.
Architecting Acceptance and Softening to Openness
Adversity happens. Whether we cope with, learn from, or succumb to it determines its impact on our lives. Being open to accept and deal with adversity in a positive way might well be the difference between suffering, and finding a way out.
1- Hayes, S. C. (2004). Acceptance and commitment therapy, relational frame theory, and the third wave of behavioral and cognitive therapies. Behavior therapy, 35(4), 639-665.
2- Chawla, N., & Ostafin, B. (2007). Experiential avoidance as a functional dimensional approach to psychopathology: An empirical review. Journal of clinical psychology, 63(9), 871-890.
3- Hayes, S. C. (2002). Buddhism and acceptance and commitment therapy. Cognitive and Behavioral Practice, 9(1), 58-66.
4- Hayes, S. C., Luoma, J. B., Bond, F. W., Masuda, A., & Lillis, J. (2006). Acceptance and commitment therapy: Model, processes and outcomes. Behaviour Research and Therapy, 44(1), 1-25.
5- Bond, F. W., Hayes, S. C., Baer, R. A., Carpenter, K. M., Guenole, N., Orcutt, H. K., … & Zettle, R. D. (2011). Preliminary psychometric properties of the Acceptance and Action Questionnaire–II: A revised measure of psychological inflexibility and experiential avoidance. Behavior therapy, 42(4), 676-688.
6- McCracken, L. M., Chilcot, J., & Norton, S. (2015). Further development in the assessment of psychological flexibility: A shortened Committed Action Questionnaire (CAQ‐8). European Journal of Pain, 19(5), 677-685.
7- Cullen, C. (2008). Acceptance and commitment therapy (ACT): A third wave behaviour therapy. Behavioural and Cognitive Psychotherapy, 36(6), 667-673.